When, What, and How: Practical Approaches to Insulin Use in Type 2 Diabetes

Ju-Ying JiangTaiwan Speaker When, What, and How: Practical Approaches to Insulin Use in Type 2 DiabetesPractical insulin use in type 2 diabetes (T2D) requires clear decisions on when to start therapy, what regimen to choose, and how to titrate effectively. Insulin is indicated when lifestyle measures and non-insulin medications fail to achieve glycemic goals, especially when Hba1c is ≥10%, fasting glucose is >250–300 mg/dL, or when patients show symptomatic hyperglycemia or catabolic features. Insulin is also required during acute illness, surgery, pregnancy, or corticosteroid use. Basal insulin remains the preferred first step due to its simplicity and lower hypoglycemia risk. Long-acting insulin analogues such as Glargine or Degludec are commonly initiated at 10 units or 0.1–0.2 U/kg/day with stepwise titration. When additional blood sugar control is needed, options include adding a GLP-1 receptor agonist, moving to basal-plus or basal-bolus regimens, or using premixed insulin for patients with fixed routines. Importantly, once-weekly basal insulin formulations—such as insulin icodec—are emerging as a future option, offering flatter pharmacokinetics and the potential to improve adherence by reducing injection frequency. These agents may simplify initiation and long-term management for patients hesitant about daily injections. Overall, individualized regimen selection, structured titration, and patient-centered education remain essential for safe and effective insulin therapy.